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According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays 

a valid OMB control number. The valid OMB control number for this information collection is 0579-0430. The time required to complete this information collection is estimated to 

average .25 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and 

reviewing the collection of information. 

OMB Approved 

0579-0430 

Exp. 02/2025

UNITED STATES DEPARTMENT OF AGRICULTURE 

ANIMAL AND PLANT HEALTH INSPECTION SERVICE 

VETERINARY SERVICES 

NATIONAL VETERINARY SERVICES LABORATORIES (NVSL) 

P.O. BOX 844, 1920 DAYTON AVENUE, AMES, IA 50010 

PHONE: 515-337-6200 FAX: 515-337-7402 

EMAIL: nvsl_concerns@aphis.usda.gov 

REQUEST FOR REAGENTS OR SUPPLIES 

1. Ship To (Business Name and Name of Individual Contact): 2. NVSL Submitter ID: 

Email Address: 

Phone Number: Fax Number: 

Shipping Address (Street, City, State, ZIP Code): 

3. Bill To: Check if same as Block 1 (Ship To) 

Email Address: 

Phone Number: Fax Number: 

Billing Address: 

4. Payment Method 

User Fee Account Number: Check/Money Order Number: 

(Enclosed, payable to USDA in United States dollars) 

Credit Card Number: 

Expiration Date: 

5. Reagents and Supplies Requested (See instructions. Limit to 10 items per form.) 

Reagent Code 

Number Reagent or Item Name Qty. Remarks 

6. Printed Name of Requestor: Signature of Requestor: Date: 

7. Phone Number of Requestor (If not provided in Block 1 or 3): 8. Date of Request: 

NVSL USE ONLY 

ORDER NUMBER 

VS FORM 4-9 

APR 2017 
 

 

 

 

 

 

 

 

 

VS FORM 4-9 INSTRUCTIONS 

Complete the form according to the following instructions. Incomplete or incorrectly completed forms will delay 

shipment and may result in errors. Print legibly or type all information. 

Orders are accepted via mail, fax, or email. Do not submit the same order via more than one method or it will be 

duplicated. 

1. The name of a contact person and a complete shipping address is required. Do not use P.O. Box numbers. A phone number is 

required. No orders will be shipped unless a telephone number is provided. Provide a fax number and/or email address, if 

available. 

2. If you have previously ordered reagents or supplies from the NVSL, you will have been assigned a NVSL identification 

number; this is the number to enter in block number 2. If you are a new customer, NVSL will assign an identification 

number when this order form is received. 

3. If the billing address is the same as the shipping address, check the box to indicate this. Otherwise, provide the name 

of a contact person for billing, a complete billing address, phone number, and fax number and/or email address, if 

available. 

4. Prepayment is required unless the requested items are to be billed to a user fee account number. If services are to be 

billed to a user fee account, be sure to include the 7-digit account number in the applicable space provided. Prepayment 

may be in the form of check, money order, or credit card. Make check or money order payable to "USDA" in United States 

dollars and attach it to this form. If paying by credit card, include the account number and expiration date. See the User 

Fee page on the NVSL Web site or contact NVSL for a list of currently accepted credit cards. 

5. A catalog of available reagents and supplies is posted in the NVSL Reagent Manual. 

The Reagents and Supplies Requested section must include the reagent code number (obtained from the catalog), 

reagent or item name, and the quantity requested. Additional comments may be recorded in the Remarks section. 

6. The name of the person (print or type) authorizing the request and his/her signature must be included with the date 

signed. 

7. If the telephone number of the person authorizing the request is different from the telephone number of the contact 

person, complete this section. 

8. Add the date of the request. 

***If you are requesting a live pathogen, be sure to include a copy of your valid USDA veterinary permit with your 

request.***